| NPI | 1396159414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OH 35144384) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA L-259169) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-08-09 |